Cholangiocarcinoma is a rare tumor among all populations of the world and accounts for less than 2% of cancers found at autopsy and between 10% and 20% of all primary liver cancers. The tumor originates either from the intrahepatic small duct
radicles(peripheral type) or the major hepatic ducts at or near the junction of the right and left hepatic ducts(hilar type). Included in the latter are the small intraduct carcinomas arising at the difurcation of the hepatic ducts.
Most of the patients with hilar type of cholangiocarcinoma are diagnosed with a symptom of obstructive jaundice by biliary obstruction. However, in peripheral type of cholangiocarcinoma, it is rare for jaundice to occur as an initial presenting
finding.
In cholangiocarcinoma, jaundice is usually cased by the infiltrating tumor. And rarely hemobilia may bring about jaundice. Hemobilia is usually developed in the biliary tract injury, intrabiliary parasities, mucosal injury by the gallstone, and
hepatoma. But hemobilia is rarely caused by the cholangiocarcinoma.
A 42 year old woman was admitted to hospital due to pruritus and jaundice. Ultrasonograpy, abdominal CT and endoscopic ultrasonograpy were performed and revealed a round solid mass at left lobe of the liver with dilatation of left lateral
intrahepatic
duct and amorphous materials in bile duct. Endoscopic retrograde cholangiogram revealed hemobilia from the orifice of duodenal papilla and a lot of blood clots in biliary tree without delineation of left intrahepatic duct. The patient was managed
by
left lobectomy of the liver, cholecystectomy, resection of the bile duct, lymph node dissection, ductoplasty, hepatico-jejunostomy, and internal stent insertion. Pathological examination of the surgical specimen confirmed the diagnosis of
peripheral
type of cholangiocarcinoma.
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